Is American College of Surgeons NSQIP Organ Space Infection a Surrogate for Pancreatic Fistula?

Abstract

Structured Abstract Background In the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) pancreatic fistula has not been monitored, although organ space infection (OSI) data are collected. Therefore, the purpose of this analysis was to determine the relationship between ACS NSQIP organ space infection and pancreatic fistulas. Study Design From 2007-11, 976 pancreatic resection patients were monitored via ACS NSQIP at our institution. From this database, 250 patients were randomly chosen for further analysis. Four patients were excluded because they underwent total pancreatectomy. Data on OSI were gathered prospectively. Data on pancreatic fistulas and other intra-abdominal complications were determined retrospectively. Results Organ space infections (OSIs) were documented in 22 patients (8.9%). Grade B (n=26) and C (n=5) pancreatic fistulas occurred in 31 patients (12.4%) while Grade A fistulas were observed in 38 patients (15.2%). Bile leaks and gastrointestinal (GI) anastomotic leaks each developed in five (2.0%) patients. Only 17 of 31 Grade B and C pancreatic fistulas (55%), and none of 38 Grade A fistulas were classified as OSIs in ACS NSQIP. In addition, only two of five bile leaks (40%) and two of five GI anastomotic leaks (40%) were OSIs. Moreover, three OSIs were due to bacterial peritonitis, a chyle leak and an ischemic bowel. Conclusions This analysis suggests that the sensitivity (55%) and specificity (45%) of Organ Space Infection (OSI) in ACS NSQIP are too low for OSI to be a surrogate for Grade B and C pancreatic fistulas. We conclude that procedure-specific variables will be required for ACS NSQIP to improve outcomes following pancreatectomy.

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Hemorrhage after pancreaticoduodenectomy: does timing matter?

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